Effect of arterial blood bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea

Blood Gas Analysis ◽

Gas Analysis ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Arterial Blood ◽

Abstract Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening.

Effect of arterial blood bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01720-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chong Pei ◽

Shuyu Gui

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Arterial Blood ◽

Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea

Journal of Applied Physiology ◽

10.1152/jappl.1985.59.5.1364 ◽

1985 ◽

Vol 59 (5) ◽

pp. 1364-1368 ◽

Cited By ~ 72

Author(s):

T. D. Bradley ◽

D. Martinez ◽

R. Rutherford ◽

F. Lue ◽

R. F. Grossman ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Linear Regression Analysis ◽

Gas Analysis ◽

Apnea Hypopnea Index ◽

Pulmonary Mechanics ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Nocturnal Hypoxemia ◽

Among patients with similar degrees of obstructive sleep apnea (OSA) there is considerable variability in the degree of associated nocturnal hypoxemia. The factors responsible for this variability have not been clearly defined. Therefore we studied 44 patients with OSA to identify the physiological determinants of nocturnal arterial O2 saturation (SaO2). All patients underwent pulmonary function testing, arterial blood gas analysis, and overnight polysomnography. Mean nocturnal SaO2 ranged from 96 to 66% and apnea-hypopnea index from 11 to 128 per hour of sleep. Several anthropometric, respiratory physiological, and polysomnographic variables that could be expected to influence nocturnal SaO2 were entered into a stepwise multiple linear regression analysis, with mean nocturnal SaO2 as the dependent variable. Three variables [awake supine arterial PO2 (PaO2), expiratory reserve volume, and percentage of sleep time spent in apnea] were found to correlate strongly with mean nocturnal SaO2 (multiple R, 0.854; P less than 0.0001) and accounted for 73% of its variability among patients. Body weight, other lung volumes, and airflow rates influenced awake PaO2 and expiratory reserve volume but had no independent influence on nocturnal SaO2. In a further group of 15 patients with OSA a high correlation was obtained between measured nocturnal SaO2 and that predicted by the model (r = 0.87; P less than 0.001). We conclude that derangements of pulmonary mechanics and awake PaO2 (generally attributable to obesity and diffuse airway obstruction) are of major importance in establishing the severity of nocturnal hypoxemia in patients with OSA.

Association between obstructive sleep apnea and persistent-postural perceptual dizziness

Journal of Vestibular Research ◽

10.3233/ves-201508 ◽

2021 ◽

pp. 1-6

Author(s):

Anand K. Bery ◽

Jayson Lee Azzi ◽

Andre Le ◽

Naomi S. Spitale ◽

Judith Leech ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Berlin Questionnaire ◽

Future Studies ◽

Obstructive Sleep ◽

Chronic Dizziness ◽

Patients At Risk ◽

The Mean ◽

The Relationship

BACKGROUND: Obstructive sleep apnea (OSA) has been linked to vestibular dysfunction, but no prior studies have investigated the relationship between Persistent Postural Perceptual Dizziness (PPPD), a common cause of chronic dizziness, and OSA. OBJECTIVE AND METHODS: We determined the frequency of OSA in an uncontrolled group of PPPD patients from a tertiary dizziness clinic based on polysomnogram (PSG). We then assessed the sensitivity and specificity of common OSA questionnaires in this population. RESULTS: Twenty-five patients with PPPD underwent PSG (mean age 47, 60% female, mean BMI 29.5). A majority, or 56%, of patients were diagnosed with OSA, and in most, the OSA was severe. OSA patients were older (56 years versus 40 years, p = 0.0006) and had higher BMI (32 versus 26, p = 0.0078), but there was no clear gender bias (56% versus 64% female, p = 1.00). The mean sensitivity and specificity of the STOP BANG questionnaire for detecting OSA was 86% and 55%, respectively. Sensitivity and specificity of the Berlin Questionnaire was 79% and 45%, respectively. CONCLUSIONS: The prevalence of OSA was much higher in our small PPPD group than in the general population. Screening questionnaires appear to demonstrate good sensitivity to detect PPPD patients at risk of OSA in this small study. Future studies should confirm these findings and determine whether treatment of OSA improves symptoms in PPPD.

Interlink between Obesity Hypoventilation Syndrome and Obstructive Sleep Apnea. Do we need to screen patients for OHS in obese OSA patients?

Journal of Diabetes and Endocrine Association of Nepal ◽

10.3126/jdean.v4i1.30058 ◽

2020 ◽

Vol 4 (1) ◽

pp. 17-20

Author(s):

S.S. Dhakal ◽

R. Maskey ◽

M. Bhattarai

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Research Centre ◽

Apnea Hypopnea Index ◽

Obese Patients ◽

Obesity Hypoventilation Syndrome ◽

Arterial Blood ◽

Obstructive Sleep ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation

Introduction: Around 90% of patients with OHS have coexistent obstructive sleep apnea (OSA) defined by an apnea–hypopnea index (AHI) >5 events/h, with nearly 70% having severe OSA (AHI > 30 events/h). Prevalence of OHS is between 8% and 20% in obese patients referred to sleep centers for evaluation of SDB. As prevalence of OHS in OSA patients data from Nepal is not available we planned to carry out the study and to address gaps in diagnosis and management. Methodology: This is a cross sectional observational study done in OM hospital and research centre from 2018 January to 2019 June. Awake daytime Arterial blood gas ( ABG) was obtained and patients having PaCO2 more than 45 mmHg were diagnosed as obesity hypoventilation syndrome in a recently diagnosed patients with OSA. Results: 32 patients diagnosed to have OSA and whose BMI is more than 30 were included in the study. Among 32 patients 26 (81.25%) were male and 6 (18.75) were female. Among all patients who underwent level A polysomnography 3 (12.5%) had mild OSA,4(16.66%) had moderate and 17 (53.12%) had severe OSA. 8 (25%) patients had normal diagnostic polysomnography. Among these patients 3(12.5%) who had mild OSA has BMI between 30-35,16 (66.66%) patients who had BMI between 30-35, 2 had mild 3 had moderate and 11 had severe OSA. Patients with BMI more than 40,5 (28.3%) had OSA among which 21 had moderate and 4 had severe OSA. Conclusions: As OHS is often misdiagnosed even in patients with severe obesity, we strongly recommended screening in obese patients with OSA for OHS as early recognition and effective treatment are important in improving morbidity and mortality in this group of patients.

Are Sleep Questionnaires Valid in All Adult Age Groups as Screening Tools for Obstructive Sleep Apnea?

Journal of Rhinology ◽

10.18787/jr.2018.00278 ◽

2020 ◽

Vol 27 (2) ◽

pp. 90-94

Author(s):

Ho Min Lee ◽

Jae Ki Kim ◽

Jung Gwon Nam ◽

Tae-Hoon Lee

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Age Groups ◽

Area Under The Curve ◽

Screening Tools ◽

Apnea Hypopnea Index ◽

Adult Age ◽

Age Related ◽

Background and Objectives: Evaluation of Epworth Sleepiness Scale (ESS), Berlin, STOP, and STOP-Bang questionnaire validities for obstructive sleep apnea (OSA) screening among various adult age groups.Materials and Method: Results for each of those questionnaires were compared with diagnostic overnight polysomnography (PSG) data obtained for 396 patients suffering either insomnia, sleep apnea, excessive daytime sleepiness, or chronic snoring who had been divided into three age groups (20-39, 40-59, or ≥60 years). For each questionnaire, the sensitivity, specificity, accuracy, and area under the curve (AUC) were calculated.Results: Among the OSA group [apnea hypopnea index (AHI) cutoff ＞5], Berlin and STOP questionnaire sensitivity and specificity were significantly different among the age groups. Among the moderate-to-severe OSA sub-group (AHI cutoff ＞15), the specificity of Berlin, STOP, and STOP-Bang questionnaire was significantly different among age groups.Conclusion: The Berlin and STOP questionnaires differed with patient age in OSA screening. The ESS questionnaire, by contrast, did not show any age-related differences of sensitivity and specificity in OSA screening or moderate-to-severe OSA screening.

A single-center validation of the effectiveness photoplethysmography-based smart device in screening obstructive sleep apnea (Preprint)

10.2196/preprints.18841 ◽

2020 ◽

Author(s):

Yibing Chen ◽

Weifang Wang ◽

Yutao Guo ◽

Hui Zhang ◽

Yundai Chen ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Large Scale ◽

World Health ◽

Smart Devices ◽

Smart Device ◽

Apnea Hypopnea Index ◽

Apnea Test ◽

BACKGROUND Obstructive sleep apnea (OSA), the most common upper-airway disease, is closely associated with cardiovascular risk. However, the early detection of OSA is challenging, relying on polysomnography (PSG) or home sleep apnea test (HSAT) in hospitals. A novel technology, PPG (Photoplethysmography), has been developed for OSA screening. However, the validation of PPG-based smart devices is limited as compared to that for PSG or HSAT. OBJECTIVE This study aimed to investigate the feasibility and validity of PPG-based smart devices in the detection of OSA. METHODS A total of 119 consecutive outpatients were recruited from the Chinese PLA General Hospital and assessed using a smart watch, PSG or HSAT for a whole night sleep. RESULTS 17/119 patients were excluded due to poor quality of PPG-signals. Among the rest, 83 patients were diagnosed with OSA. Compared to HSAT devices, the accuracy, sensitivity, and specificity of PPG-based smart device in predicting moderate to severe OSA patients (Apnea Hypopnea Index, AHI≥15) were 87.9%, 89.7%, and 86.0%, respectively. Compared to PSG, the accuracy, sensitivity, and specificity in predicting the sleep apnea in patients (AHI≥5) were 81.1%, 76.5%, and 100%, respectively. Moreover, for moderate to severe OSA patients (AHI≥15), the predictive ability of PPG-based smart device in OSA did no differ significantly as compared to HSAT (P=0.75) or PSG (P=0.52). CONCLUSIONS The PPG-based smart devices demonstrated good performance in detecting OSA; nevertheless, validation in a large-scale population is imperative. CLINICALTRIAL Chinese Clinical Trial Registry of the International Clinical Trials Registry Platform of the World Health Organization ChiCTR-OOC-17014138; http://www.chictr.org.cn/showprojen.aspx?proj=24191.

Euthyroid goitre and sleep apnea

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2006.588 ◽

2016 ◽

Vol 65 (1) ◽

Author(s):

A. De Felice ◽

S. Fuschillo ◽

M. Martucci ◽

E. De Angelis ◽

G. Balzano

Keyword(s):

Sleep Apnea ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Gas Analysis ◽

Apnea Hypopnea Index ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Volume Curve ◽

Obstructive Sleep ◽

Euthyroid Goitre

A number of predisposing factors (obesity, nasal obstruction, adenoidal hypertrophy, macroglossia, etc) have been related to obstructive sleep apnea syndrome (OSAS). In addition hypothyroidism and large goitres have been reported to be associated to OSAS, but this association has not been adequately studied. We describe an obese patient with euthyroid goitre associated with OSAS. The patient showed a body mass index (BMI) of 47 and a large neck with a circumference of 60 cm. The flow-volume curve demonstrated an expiratory plateau suggesting an intrathoracic upper airway obstruction. Arterial blood gas analysis results were: pH 7.39; PCO2 54.2 mmHg; P O2 47 mmHg. Nocturnal polisomnography showed an apnea/hypopnea index (AHI) of 31 episodes/hour. Upper airway collapse was overcome by a nasal continuous positive airway pressure (nCPAP) of 14 cmH2O. Weight loss obtained by a hypocaloric diet was not accompanied by any OSAS improvement. After thyroidectomy, a nCPAP of 4 cmH2O was sufficient to prevent upper airway closure. Discontinuation of nCPAP treatment for 4 consecutive nights did not determine worsening of sleep apnea symptoms, nor a worsening of overnight oxymetry. A new polysomnography carried out after 4 nights off nCPAP showed an AHI of 33 episodes/hour. OSAS should be suspected in patients with large goitres. Decisions regarding discontinuation of nCPAP treatment after thyroidectomy should be based on polisomnographic results.

0691 Comparison Of Odds Ratio Product And Other Polysomnographic Metrics Among Responders And Non-responders To Upper Airway Stimulation Treatment Of Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.687 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A263-A264

Author(s):

J L Yu ◽

B T Keenan ◽

S T Kuna ◽

M Younes

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Odds Ratio ◽

Upper Airway ◽

Research Society ◽

Apnea Hypopnea Index ◽

Upper Airway Stimulation ◽

Sleep Depth ◽

Abstract Introduction Upper airway stimulation (UAS) is a surgical method of treating obstructive sleep apnea (OSA). UAS involves an implantable neuro-stimulator that stimulates the hypoglossal nerve to protrude the tongue during sleep. OSA fails to improve in 22% of patients who receive UAS as defined by a > 50% reduction in Apnea-Hypopnea Index (AHI) and an AHI <20 events/hour. Light sleep may predict UAS failure in that it may limit the stimulus strength that can be applied. The odds ratio product (ORP) is a novel polysomnographic (PSG) metric of sleep depth. We hypothesized that ORP values prior to surgery will be higher (lighter sleep) in non-responders. Having markers that predict surgical success can help reduce unnecessary surgeries. Methods This is a retrospective cohort study of 126 patients (83 responders vs. 43 non-responders) who received UAS implantation for the treatment of OSA. PSG data was obtained from the Stimulation for Apnea Reduction (STAR) trial. Raw baseline PSG data were analyzed and ORP values calculated using Michele Sleep Scoring Software (Cerebra Medical, Winnipeg, CA). In addition, 13 PSG metrics that were considered possibly relevant to surgical outcome were calculated as an exploratory analysis. The measurements included: spindle density, spindle power, spindle frequency, alpha intrusion, Right/Left sleep depth correlation coefficient, respiratory duty cycle, respiratory flow limitation, and arousal intensity. Statistical Analysis: Comparisons between responders and non-responders used parametric t-tests for continuous data and chi-squared or Fisher’s exact tests for categorical data. Statistical significance was based on a Bonferroni-corrected p<0.00357. Results Differences in ORP values and other PSG metrics between responders and non-responders were not statistically significant. Of all PSG metrics only differences in spindle density approached statistical significance (Responders = 2.33 spindles/minute vs Non-Responders = 1.39 spindles/minute, p=0.00360). Conclusion The findings suggest that differences in sleep depth and several other sleep characteristics do not play a significant role in determining response to UAS therapy. Support This project was supported by a Sleep Research Society Career Development Award #023-JP-19

Efficacy of a Pre-Fabricated Myofunctional Appliance for the Treatment of Mild to Moderate Pediatric Obstructive Sleep Apnea: A Preliminary Report

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4625-42.6.14 ◽

2018 ◽

Vol 42 (6) ◽

pp. 475-477 ◽

Cited By ~ 4

Author(s):

Luca Levrini ◽

Giussepa Sara Salone ◽

German O Ramirez-Yanez

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Experimental Period ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Significant Difference ◽

Before And After ◽

Cent Level ◽

The Stability

Objective: The purpose of this study was to determine the efficacy of the Myobrace/MyOSA myofunctional appliance for the treatment of mild to moderate Obstructive Sleep Apnea (OSA) in children, by means of the Apnea/Hypopnea Index (AHI). Study design: Nine children with a diagnosis of mild to moderate OSA were included in the study. The subjects wore the Myobrace/MyOSA myofunctional appliance for a period of 90 days. The initial AHI, determined by means of a sleep test, was used as baseline (To), and a second AHI, computed at the end of the experimental period, was used as final data (T1). The differences between the AHIs at To and T1 were calculated (diff AHI) and used for statistical purposes. The level of Oxygen Saturation (SaO2) was also recorded before and after treatment, and their differences calculated as diff SaO2. Statistical analysis was performed with a paired-t- test and statistical significance was established at 95 per cent level of confidence. Results: A statistical significant reduction in the AHI of the studied subjects was computed at the end of the experimental period (p = 0.0425). Although there was an improvement in the SaO2, it did not reach a statistically significant difference. Conclusions: The present results suggest that the Myobrace/MyOSA myofunctional appliance can be an alternative to treat mild to moderate OSA in children. However further studies are necessary to determine the stability of the results after treatment.

Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness

Medicina ◽

10.3390/medicina57040335 ◽

2021 ◽

Vol 57 (4) ◽

pp. 335

Author(s):

Karolina Charčiūnaitė ◽

Rasa Gauronskaitė ◽

Goda Šlekytė ◽

Edvardas Danila ◽

Rolandas Zablockis

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Effectiveness ◽

Response To Treatment ◽

Periodic Limb Movements ◽

Apnea Hypopnea Index ◽

Arterial Blood Gas ◽

Treatment Techniques ◽

Arterial Blood ◽

Background and Objective: Obstructive sleep apnea (OSA) is a heterogeneous chronic sleep associated disorder. A common apnea-hypopnea index (AHI)-focused approach to OSA severity evaluation is not sufficient enough to capture the extent of OSA related risks, it limits our understanding of disease pathogenesis and may contribute to a modest response to conventional treatment. In order to resolve the heterogeneity issue, OSA patients can be divided into more homogenous therapeutically and prognostically significant groups–phenotypes. An improved understanding of OSA phenotype relationship to treatment effectiveness is required. Thus, in this study several clinical OSA phenotypes are identified and compared by their treatment effectiveness. Methods and materials: Retrospective data analysis of 233 adult patients with OSA treated with continuous positive airway pressure (CPAP) was performed. Statistical analysis of data relating to demographic and anthropometric characteristics, symptoms, arterial blood gas test results, polysomnografic and respiratory polygraphic tests and treatment, treatment results was performed. Results: 3 phenotypes have been identified: “Position dependent (supine) OSA” (Positional OSA), “Severe OSA in obese patients” (Severe OSA) and “OSA and periodic limb movements (PLM)” (OSA and PLM). The highest count of responders to treatment with CPAP was in the OSA and PLM phenotype, followed by the Positional OSA phenotype. Treatment with CPAP, despite the highest mean pressure administered was the least effective among Severe OSA phenotype. Conclusions: Different OSA phenotypes vary significantly and lead to differences in response to treatment. Thus, treatment effectiveness depends on OSA phenotypes and treatment techniques other than CPAP may be needed. This emphasizes the importance of a more individualized approach when treating OSA.